Apparatus and method for ventilating and aspirating

ABSTRACT

A sealed ventilation circuit adapter that enables simultaneous patient ventilation and safe tracheal suctioning is embodied to accommodate any of a wide variety of commercially available suction catheters. The adapter comprises a manifold assembly, and a catheter carrier. The manifold assembly may be attached to a patient for an extended period, while the catheter carrier is advantageously constructed as a single procedural use disposable device. The carrier couples with the manifold assembly and functions to effect an introduction of a catheter through a normally closed valve structure carried by the manifold assembly.

RELATED APPLICATIONS

This application is a continuation of application Ser. No. 08/091,324filed Jul. 14, 1993 now U.S. Pat. No. 5,513,628.

BACKGROUND OF THE INVENTION

1. Field

This invention relates to means for ventilating and aspirating therespiratory tracts of medical patients. It is particularly directed toan improved ventilation circuit adapter.

2. State of the Art

Currently available means for ventilating and aspirating congested lungsand obstructed breathing passage ways may be classified as either"simple" or "complex." Devices of both classes have significantdrawbacks and limitations. The available devices of simple constructiontend to expose both the patient and the service provider to microbialcontaminants. Although these devices are relatively less expensive,their use potentially provides dangerously inadequate patientventilation during the aspirating procedure. More elaborate devices tendto be physically obstructive and economically prohibitive to use. Incommon medical practice, a medical practitioner inserts a trachealsuctioning catheter into a medical patient's lungs. The catheter may bepositioned within a tracheal tube, endotracheal tube or nasopharyngealtube intubated at a tracheotomy incision, mouth or nasal opening,respectively. The end of the catheter accessible by the medicalpractitioner is regarded as its "proximal" end. The end of the catheterremote from the practitioner, that is, within the patient, is regardedas its "distal" end. In a typical procedure, negative pressure isexerted at the proximal end of the catheter. Undesired respiratoryfluids and mucoid secretions are thereby evacuated from the medicalpatient through the distal end of the catheter.

In a relatively simple practice, a source of vacuum pressure remainsattached to the proximal catheter end. Negative pressure is notcommunicated to the distal catheter end initially. Rather, negativepressure is communicated to an aperture near the proximal catheter end.When aspiration of the patient is desired, the practitioner plugs theaperture, normally with a finger or thumb. Negative pressure is therebyinstantaneously diverted from the small aperture near the proximalcatheter end through the catheter lumen to the distal end of thecatheter. In this fashion, undesired respiratory fluids are aspiratedfrom the respiratory tract of the patient. The suctioning catheter isthen disconnected from the vacuum source and discarded after a singleuse.

Ventilation of the patient simultaneously with this aspirating procedureis generally impractical. Such ventilation inherently requiresassistance from additional personnel as well as mechanical assistance,neither of which is available as a matter of course. Accordingly, theaspirating procedure must ordinarily be completed within a short periodof time. Otherwise, the patient may experience oxygen deficiency and beexposed to the resulting potential for heart arrhythmia and/or failure.

More complex aspirating devices are available, which while avoiding someof the disadvantages attendant to the structurally more simple devices,impose additional disadvantages. For example, they are significantlymore expensive to construct, and their greater number of moving partsincreases the risk of disfunction during use. They are also larger andmore cumbersome to use, imposing a greater physical interference withother, related procedures.

The complex, closed-system devices are characteristically comprised of amanifold structure enabling introduction of ventilating gases andintermittent exhalation of patient breath simultaneously with insertionand operation of the tracheal suctioning catheter. These systems almostuniversally involve at least one collapsible, plastic envelope entirelysurrounding the catheter and purporting to provide a sterile barrierbetween the otherwise exposed external surface of the catheter and theambient atmosphere. In practice, a practitioner manually externallycollapses the envelope onto the external surface of the catheter andadvances the catheter into the throat of a patient, retracting thecatheter in a similar fashion following the aspiration procedure.

These closed-system devices under present medical protocol areordinarily used at least hourly for up to 48 hours for each patientbefore being replaced. Problems attendant to such frequent and repeatedin-dwelling use are numerous, among other problems constriction of thecatheter lumen and valve flow path with dried and drying phlegm andother respiratory secretions, creation of contaminant-allowing pinholesin the collapsible plastic barrier and the need to physically move thelengthy and cumbersome devices from one location on the body of thepatient to another when the devices interfere with other procedures.Associated with the dried and drying secretions inside the lumen arelike secretions on the exterior of the catheter wall which accumulate atthe manifold wiper seal; such thick and undesired respiratory secretionsnot only restrict the facile movement of the catheter through themanifold, but also can be unavoidably reintroduced to the patient insubsequent repeat procedures.

Material prior art structures and methods are described among otherplaces in U.S. Pat. Nos. 5,133,345 to Lambert; 5,107,829 to Lambert;5,083,561 to Russo; 5,065,754 to Jensen; 5,029,580 to Radford et al.;5,025,806 to Palmer et al.; 4,981,466 to Lambert; 4,967,743 to Lambert;4,938,741 to Lambert; 4,872,579 to Palmer; 4,838,255 to Lambert;4,836,199 to Palmer; 4,834,726 to Lambert; 4,825,859 to Lambert;4,805,611 to Hodgkins; 4,696,296 to Palmer; 4,638,539 to Palmer;4,569,344 to Palmer; 4,327,723 to Frankhouser; and 3,991,762 to Radford.

Other closed-system, sterility preserving devices which involve sterilebarriers formed of rubber-like materials and intended for penetration byrigid cannulae include: rubber like caps fitted on "y" injection sitestructures and located at the end of indwelling intravenous catheters,such as those distributed by HARMAC Medical Specialties, Inc. ofBuffalo, N.Y. under the product number H1429104; rubber-like caps fittedon housing structure anchorable at injection sites, such as thosedistributed by Baxter Healthcare Corp. of Deerfield, Ill. under productnumber 2N3399 and their trademark "InterLink(TM);" and threaded lockcannula used in conjunction with the Baxter InterLink(TM) for needlelessinjection by Becton Dickinson & Co. of Franklin Lakes, N.J. underproduct number 303369 and their trademark "InterLink(TM)."

U.S. Pat. No. 4,351,328 to Bodai discloses a method and apparatus foraccomplishing endotracheal suctioning of a patient without the need fordisconnecting the patient from a respirator. The disclosed apparatuspermits the maintenance of positive end expiratory pressure withoutinterruptions during suctioning. A notable feature of the device is theease with which a suctioning tube may be removed from an associatedventilation manifold.

There remains a need for a ventilating and aspirating device, wherein aclosed-system, multiple use manifold for a single patient is coupledwith a single-patient, single use catheter, which structure is comprisedof relatively few parts, is easily assembled and is not susceptible todisfunction.

Also, a need remains for a tracheal suctioning device whichunobtrusively enables ongoing closed-system ventilation and repeatedaspiration of a single patient without interim obstruction of peripheralprocedures.

SUMMARY OF THE INVENTION

The present invention provides an improved apparatus and method forsimultaneously ventilating and aspirating a medical patient. It may beembodied as a sealed ventilation circuit adapter that enablessimultaneous patient ventilation and safe tracheal suctioning.

The adapter of this invention may be embodied to accommodate any of awide variety of commercially available suction catheters. Catheters withflared tips, obvious depth markings, and normally closed vacuum controlvalves are presently considered to be most useful. Currently preferredembodiments of the adapter comprise two primary components: a manifoldassembly, and a catheter carrier. The manifold assembly will ordinarilybe attached to a patient for an extended period, typically 24-48 hours.The catheter carrier is advantageously constructed as a singleprocedural use disposable device; it is ideally constructed to acceptinterchangeably a variety of commercially available catheters.

The invention enables a practitioner to insert a flexible catheter tubeinto either lung of a patient in one smooth motion without risk ofcontamination or infection and without assistance from others.Additionally, a practitioner is able to activate vacuum pressure witheither hand and without assistance from others.

A standard flexible tracheal suctioning catheter tube is attached at theproximal (practitioner) end to a fitting cylinder for insertion into avacuum source. The cylinder includes an offset opening which whenplugged transfers communication of the vacuum pressure from outside thecatheter to the internal lumen of the catheter. The distal (patient) endof the catheter tube is structured to permit respiratory secretions tobe suctioned into the lumen of the catheter tube.

The catheter tube is slidable lengthwise through a passageway in amulti-function manifold positioned at the distal end of the apparatus.The manifold preferably includes a port at the distal end for attachmentto and communication with an indwelling intubation device, such as atracheal tube, endotracheal tube or nasopharyngeal tube. The manifoldalso preferably includes a ventilating structure extending radially fromand in fluid communication with the passageway, for selectivelyintroducing ambient air, oxygenated air and other therapeutic gassesinto the respiratory system of the patient. Other conduits may also beprovided for the introduction of other suitable gases and lavagesolutions to the respiratory system.

Specifically, this invention provides an advantageous ventilationcircuit adapter for interfacing a suction catheter with an intubationdevice. The adapter may be visualized as comprising two majorcomponents; specifically, a manifold assembly and a catheter carrier. Inpractice, the adaptor may be associated in a package or kit with one ormore catheters. Alternatively, a manifold assembly may be associatedwith a plurality of catheter carriers.

The manifold generally has a body with an open interior. A distal endportion of the body is adapted to couple with an intubation device. Aproximal end portion of the body is formed as an open port defined by acontinuous wall. The manifold may take various forms, but its proximalend portion should be approximately axially aligned with its distal endportion so that a catheter may be inserted through the proximal endportion to exit from the distal end portion. A directional barrier iscarried by the proximal end portion of the manifold assembly. It isconstructed and arranged to effect a seal against fluid flow through theopen interior of the manifold towards the proximal end portion but topass a catheter introduced through the proximal end portion.

Preferably, the directional barrier is configured to be inserted in theproximal end portion in sealing relationship with the open interior, andcomprises a normally closed valving structure. The normally closed valvestructure may be constructed and arranged to effect a sliding sealarrangement with the external surface of a catheter passed through thebody of the manifold; that is, from the proximal end portion towards thedistal end portion through the valve structure. Preferably, the valveand catheter carrier are mutually adapted to effect this sliding seal.The valve structure may carry detection means constructed and arrangedto signal the precise location of the tip of a catheter positionedwithin the valve structure. For example, these means may signal, byresistance to travel or sound, the presence of the tip when it is movedto the proximity of the valve structure from a location closer to thedistal end portion of the manifold assembly.

The manifold assembly desirably includes a ventilation port in fluidflow communication with the open interior of the manifold body. Thecentral axis of the ventilation port will ordinarily be orientedtransverse the central axes of the proximal end portion and the distalend portion of the manifold. A lavage port may also be provided in fluidflow communication with the open interior. The central axis of thelavage port should also be oriented transverse the central axes of theproximal end portion and the distal end portion.

The catheter carrier typically includes a leading end portion adapted tocouple with the proximal end portion of the manifold and a trailing endportion carrying a catheter introducer structure. The introducerstructure is constructed and arranged to interface with the directionalbarrier when the leading end portion of the carrier is coupled with theproximal end portion of the manifold. For example, it may comprise anintroducer tip constructed as a continuous wall to define an interiorpassageway configured to receive and pass a catheter and an exteriorsurface configured to interface with the directional barrier. Thedirectional barrier is further preferably structured to effect aresilient seal against an internal surface of the continuous wall. Theinterior passageway may include an entry constructed and arranged toeffect a sliding seal with the exterior surface of a catheter. In anyevent, the exterior surface of the introducer tip and the directionalbarrier are mutually adapted to effect a sealed relationship when theleading end portion of the catheter carrier is coupled with the proximalend portion of the manifold body.

The directional barrier may be structured to effect a resilient sealboth against an internal surface of the open interior of the manifoldbody and between the proximal end portion of the body and the cathetercarrier.

A fluid collector may be carried by the trailing end portion of thecatheter carrier. This collector functions to accumulate sputum fluidsand the like wiped from a catheter as it is withdrawn through thebarrier seal. In one embodiment, the collector includes a chamberpositioned in approximate axial alignment with the distal end portionopposite the manifold with respect to the leading end portion. Aproximal closing member for the chamber carries an entry approximatelyaxially aligned with the introducer tip. The closing member may bestructured to effect a sliding seal with the exterior surface of acatheter.

The chamber is desirably structured as a hollow cylindrical extensionfrom the trailing end portion of the carrier. The closing member isdesirably structured as an end panel of the extension with a centralopening adapted to receive a catheter in friction-slipping engagement.The term "friction slipping," as used in this disclosure, refers to aslidable association in which the exterior surface of the catheter isengaged about its circumference by the interior surface of the centralopening of the end panel. Fluids adhering to the catheter are thusremoved by a wiping action as the catheter is withdrawn through theopening. The end panel conveniently comprises a removable cap structuredand arranged to effect a sealed closure of the cylindrical extension.

In use, the manifold assembly is interposed between a patient'sindwelling tube at the distal end of the manifold and a ventilatingcircuit. These junctions preferably embody a swivel configuration topermit left or right bedside placement of the ventilation circuitry, andfree rotation of the ventilation circuit with patient head movement toreduce the risk of extubation.

The directional barrier may be configured as an elongate pressure andsterility barrier, and the normally closed valve may be in the shape ofa duckbill, with a normally closed central aperture interposed withinthe passageway of the manifold. Whether the barrier is structured toinclude an aperture of elongate transverse dimension or a simple slit ina membranous end of the barrier wall, the barrier in combination withthe adapter assembly provides an effective seal against patientexpectoration, contaminant migration and pressure leakage.

The catheter carrier may be configured as an adapter assemblysurrounding the catheter, including an introducer tip and a concentricouter introducer housing connected at one end by an adapter base. Theintroducer housing fits snugly over the outside of the proximal end ofthe manifold. As the introducer housing is slid over the manifold, firstcoupling structure carried by the external surface of the manifoldengages second coupling structure associated with the internal wall ofthe introducer housing. The first and second coupling structures aremutually adapted to allow the practitioner to slide the adapter assemblyand manifold toward one another until the manifold is seated against theadapter base. Then the housing is rotated with respect to the adapter topositively lock the adapter and manifold together during use of thedevice.

The introducer housing may be slid over the proximal end of themanifold. An initial sterile barrier is thereby created. After theinitial barrier is created, the introducer housing is further slidtoward the manifold, causing the introducer tip to penetrate theaperture of the directional barrier. Though this penetration maypreliminarily partially compromise the aperture seal, the initialsterile barrier between the manifold and adapter maintains aclosed-system environment within the manifold. After the introducer tiphas penetrated the directional barrier, the catheter can be advanced,with minimal frictional resistance, through the manifold and indwellingtube into either lung of the patient.

Once the catheter and adapter are attached to the manifold, a presuctionsaline lavage is typically introduced through the lavage port in themanifold which directs the respiratory secretion flow into the patienttube through the distal end of the manifold. The lavage port ispurposefully located immediately adjacent to the patient tube and with anon-perpendicular fluid injection angle so as to optimally direct thesaline flow into the patient tube with little risk of back flow into theventilation circuit. One preferred manifold design incorporates a windowthrough which a practitioner may view the catheter, its suctionedcontents and any depth markings which may be printed on the catheter.

While the practitioner is performing the evacuation procedure, thecatheter may be repeatedly inserted and retracted with selectiveintroduction of lavage fluid through a lavage port on the manifold. Themanifold is configured to prevent lavage fluid from draining through theventilation port, obviating the need for the manifold to be tiltedduring lavage and thereby averting the potential for disconnection ofthe manifold from the indwelling endotracheal tube.

Upon repeated advancement and retraction of the catheter during anevacuation procedure, undesired respiratory secretions are preventedfrom flowing into the ventilation port or back toward the patient. Suchsecretions are squeegeed off of the external surface of the catheterduring retraction.

The squeegee function is accomplished by a wiper seal snugly surroundingthe catheter within the proximal end of the adapter assembly. The wiperseal has two primary functions: to clean the external catheter wallduring retraction so as to minimize practitioner exposure to patientcontaminants; and to maintain a pressure seal around the catheter,ensuring a continuous closed, leak tight ventilation circuit. Thepreferred wiper seal configuration interfaces with the catheter tubewith low frictional resistance, facilitating facile catheter insertion.

A sputum collector compartment is located between the wiper seal and thebase of the adapter to accumulate the undesired secretions. The sputumcollector or trap has two primary functions. It traps the wiper sealbetween the wiper trap and the adapter housing, and acts as a catheterguide during insertion and retraction of the catheter.

Upon completion of an evacuation procedure, a practitioner retracts thecatheter. In some arrangements, a structure, such as a flare at thedistal tip of the catheter, catches against a trap wall narrowing in thecatheter passageway within the introducer tip. This flare to trap wallcontact further enhances and maintains the closed-system environmentwithin the manifold by providing a positive stop which prevents apractitioner from inadvertently retracting a catheter from the manifoldand catheter adapter.

After the practitioner has performed the respiratory evacuationprocedure, the introducer housing may be axially rotated in thedirection opposite to the direction it was turned at the beginning ofthe procedure, thereby to decouple the adapter assembly so that it canbe retracted from the manifold.

As the adapter assembly is being retracted from the manifold, theintroducer housing maintains a closed-system seal, even as theintroducer tip within is pulled through the directional barrier. Afterthe aperture in the directional barrier is closed, thereby maintaining apressure and sterility barrier, the introducer housing is retractedproximally off from the manifold. The single use catheter and adapterassembly may then be dropped onto the sterile field barrier atop thepatient, together with the surgical gloves, and the sterile field may bewrapped around the gloves, catheter and adapter assembly and discardedappropriately, leaving the closed-system, single-patient manifold inplace for later multiple uses.

A dust cap, typically tethered to the manifold, may be placed over theproximal end of the manifold between suction procedures. The dust capacts as a protective sterile barrier between the suction procedures aswell as a seal against pressure differentials across the manifold toprevent back flow through the normally closed directional barrier.

It is significant that throughout the entirety of a respiratoryevacuation procedures, a sterile, closed-system environment ismaintained within the manifold. This invention thus makes it possiblefor such respiratory evacuation procedures to be accomplished withoutthe need for ancillary personnel assistance. An individual respiratorynurse or technician can perform the entire procedure.

Further, it is significant that this invention provides means wherebythroughout the entirety of such procedures, ongoing oxygenation or otherventilation of the patient can be maintained, without the need forrepeated disconnection, connection or other moving of ventilating tubesand other auxiliary equipment.

It is also significant that the manifold, comprising the more costlyportion of the adapter of this invention, unobtrusively remains attachedto the patient and is reusable for numerous additional suctioningprocedures with single-use catheter and carrier assemblies of relativelynegligible expense.

BRIEF DESCRIPTION OF THE ILLUSTRATED DRAWINGS

In the drawings, which illustrate what is currently regarded as the bestmode for carrying out the invention:

FIG. 1 is a partially exploded and partially broken away cross-sectionalview in elevation of a preferred embodiment of the invention indisassembled condition;

FIG. 2 is an enlargement of a portion of FIG. 1;

FIG. 3 is a view in elevation taken on the reference line 3--3 of FIG.2;

FIG. 4 is a view similar to FIG. 1, but showing the components inassembled condition;

FIG. 5 is a partially exploded and partially broken away cross-sectionalview similar to FIG. 1 of an alternative embodiment of the invention;and

FIG. 6 is a view similar to FIG. 5, showing the components in assembledcondition.

DETAILED DESCRIPTION OF THE PREFERRED EMBODIMENT

FIGS. 1-4, illustrate one configuration of a device, designatedgenerally 100, embodying the invention. A manifold assembly, designatedgenerally 105, comprises a body 110 with a distal end 115 and a proximalend 120. The body 110 defines a space 125 between the distal end 115 andproximal end 120. A lavage port 130 located on the body 110 of themanifold assembly 105 opens into and is in communication with themanifold space 125. Similarly, a ventilation port 135 located on thebody 110 is in communication with the manifold space 125. Located at thedistal end 115 of the body 110 is an endotracheal port 140 openingtoward the patient and attachable to an indwelling fixture (not shown),such as a tracheal, endotracheal or nasopharyngeal tube.

A cap 145, capable of covering the proximal end 120 of the body 110, maybe attached to the body 110 with a tether 150. Situated within the space125 of the body 110 is a directional barrier 155 preferably formed of apliant, durable, rubber-like material with strong dimensional memory.The directional barrier 155 includes a central aperture 157. Thedirectional barrier 155 is seated around its entire cross-sectionalperiphery against a rim 160 extending inwardly from the internal wall ofthe body 110. The barrier 155 and the rim 160 interface in a manner thatachieves a sealing and anchoring of the directional barrier 155 relativeto the body 110. A seal extension 165 may protrude slightly from thedirectional barrier 155 axially beyond the proximal end 120 of the body110 to provide additional sealing effect between the cap 145 and thebody 110 when the cap 145 is in position to cover the proximal end 120of the body 110.

At least one positioning and locking post 170 extends radially outwardfrom the body 110 of the manifold assembly 105. The post 170 interactswith a locking channel 175 formed in the internal wall of the introducerhousing 180 of a catheter adapter 185, as illustrated more clearly inFIG. 2. The channel 175 extends axially from the adapter front 190 inthe direction of the adapter base 195, providing relative positioning ofthe manifold assembly 105 and the catheter adapter 185. The channel 175then continues circumferentially at approximately a right angle from theaxially directed channel 175, providing a means of locking the manifoldassembly 105 and the catheter adapter 185 together when the post 170 hasbeen moved axially and then radially within the channel 175. The sealextension 165 is shown configured to seal against the internal wall ofthe introducer housing 180 as the catheter adapter 185 and manifoldassembly 105 are in the process of being assembled. The seal extension165 is further structured to seal against the adapter base 195 when thecatheter adapter 185 is locked to manifold assembly 105. In thisattached position, the resilience of the seal extension 165 biases theadapter 185 axially to maintain locking pressure between the lockingpost 170 of the manifold assembly 105 and the channel 175 of theintroducer housing 180.

The catheter adapter 185 comprises an introducer tip 200 situatedconcentric with and inside of the introducer housing 180. The introducertip 200 is seated against, and may be formed integrally with the adapterbase 195. A catheter passageway 205 is formed through the length of theintroducer tip 200, opening at the leading edge 210 and through acatheter opening 215 in the adapter base 195. The catheter opening 215may be formed with a cross-sectional dimension slightly larger than butcorresponding to the outside cross-sectional dimension of a trachealsuctioning catheter 220.

Trap walls 225 extend axially from, and are formed integrally with, theadapter base 195. A pliant and resilient washer-like wiper seal 230 witha hole 233 therethrough is placed against the distal edge 235 of thetrap walls 225. A trap cap 240 is attached to the trap walls 225 andholds the wiper seal 230 in place. The trap cap 240 includes a supportopening 245 which provides catheter guidance and relief of strain on thecatheter 220 imposed by non-axial forces encountered during insertionand retraction of the catheter 220. In combination, the wiper seal 230,the trap cap 240 and the trap wall 225 contribute to the sterility andpressure barrier function of the manifold 185 during use. The trap walls225, together with the wiper seal 230 and the trap cap 240, defme asputum collector 250.

Upon retraction of the catheter 220, sputum, phlegm and other undesiredrespiratory secretions are squeegeed from the external surface of thecatheter 220 by the wiper seal 230. The diameter of the hole 233 isdesirably sized slightly smaller than the outer diameter of the catheter220 to facilitate this function. These undesired respiratory liquids arethen directed into the sputum collector 250 where they are retained fromleakage back toward the patient or out toward the respiratorypractitioner. With the practitioner being equipped with protective handware and the patient being covered by a sterile field barrier under theretracted catheter 220, adequate protection from cross-contamination isthereby achieved.

The catheter passageway 205 narrows at a reducing constrictor 255 nearthe catheter opening 215. A flare 260 at the catheter nozzle 265 catchesagainst the reducing constrictor 255 upon retraction of the catheter220. The embodiment illustrated by FIG. 6 provides a catheter advancer270. A practitioner can press the walls of the advancer 270 down upon acatheter 220 for selectively advancing and retracting the catheter 220.In this fashion, the practitioner can manipulate the catheter withouttouching it and without the need for special hand ware.

As best shown by FIGS. 4 and 6, the device 100 and its respectivecomponents allow a respiratory practitioner to maintain a closed-systemwithin the single-patient, multiple use manifold assembly 105 throughoutattachment of the catheter adapter 185 to the manifold assembly 105,evacuation of a medical patient through ambidextrous actuation of thevacuum pressure by selectively plugging an opening 272 in an actuatorcylinder 274, retraction of the tracheal catheter 220 and detachment ofthe single-use, disposable catheter adapter 185. The practitioner maythen, with minimal waste and cost, discard the catheter 220 and adapterstructure 185 and place the cap 145 over the proximal end 120 of themanifold assembly 105 until next use, leaving no partially obstructedcatheter, plastic envelope and complicated valve structure to interferewith other procedures and auxiliary equipment.

The present invention may be embodied in other specific forms withoutdeparting from its spirit or essential characteristics. Further objectsand advantages of this invention will become apparent from aconsideration of the drawings and ensuing description of it. Thedescribed embodiments are to be considered in all respects only asillustrative, and not restrictive. The scope of the invention is,therefore, indicated by the appended claims, rather than by theforegoing description. All changes which come within the meaning andrange of equivalency of the claims are to be embraced within theirscope.

What is claimed is:
 1. A ventilation circuit adapter for interfacing asuction catheter with an intubation device, comprising:a manifoldassembly, having:a body with an open interior; a distal end portion ofsaid body being adapted to couple with said intubation device, aproximal end portion of said body being formed as an open port definedby a continuous wall, said proximal end portion being approximatelyaxially aligned with said distal end portion so that a catheter may beinserted through said proximal end portion to exit from said distal endportion; and a catheter carrier structured and arranged to associate acatheter with said proximal end portion of said body, said cathetercarrier including:a leading end portion; and a trailing end portion;both said leading end and trailing end portions being structured andarranged to engage said catheter in sliding relation, whereby toaccommodate reciprocal passage of said catheter through both said bodyand said carrier; and a fluid collector carried by said trailing endportion.
 2. A ventilation circuit adapter for interfacing a suctioncatheter with an intubation device, comprising:a manifold assembly,having:a body with an open interior; a distal end portion of said bodybeing adapted to couple with said intubation device, a proximal endportion of said body being formed as an open port defined by acontinuous wall, said proximal end portion being approximately axiallyaligned with said distal end portion so that a catheter may be insertedthrough said proximal end portion to exit from said distal end portion;a catheter carrier structured and arranged to associate a catheter,having a distal tip, with said proximal end, including:a leading endportion; and a trailing end portion; said leading end portion and saidtrailing end portion being structured and arranged to engage saidcatheter in sliding relation, whereby to accommodate reciprocal passageof said catheter through both said body and said carrier; and aninternal catheter passageway; and a positive stop mechanism arranged toprevent retraction of said distal tip of said catheter from saidcatheter carrier.
 3. An adapter according to claim 2, wherein saidpositive stop mechanism comprises a flare at said distal tip of saidcatheter.
 4. A ventilation circuit adapter for interfacing a suctioncatheter with an intubation device, comprising:a manifold assembly,having:a body with an open interior; a distal end portion of said bodybeing adapted to couple with said intubation device, a proximal endportion of said body being formed as an open port defined by acontinuous wall, said proximal end portion being approximately axiallyaligned with said distal end portion so that a catheter may be insertedthrough said proximal end portion to exit from said distal end portion;a catheter carrier structured and arranged to associate a catheter,having a distal tip, with said proximal end, including:a leading endportion; and a trailing end portion; said leading end portion and saidtrailing end portion being structured and arranged to engage saidcatheter in sliding relation, whereby to accommodate reciprocal passageof said catheter through both said body and said carrier; and aninternal catheter passageway; and a sealing mechanism at said distaltip, said mechanism structured and arranged to seal said catheterpassageway during retraction of said catheter.
 5. An adapter accordingto claim 4, wherein said sealing mechanism comprises a flare at saiddistal tip, said flare constructed and arranged to provide a slidingseal against said internal catheter passageway in said catheter carrier.6. A ventilation circuit adapter for interfacing a suction catheter withan intubation device, comprising:a manifold assembly, having:a body withan open interior; a distal end portion of said body being adapted tocouple with said intubation device, a proximal end portion of said bodybeing formed as an open port defined by a continuous wall, said proximalend portion being approximately axially aligned with said distal endportion so that a catheter may be inserted through said proximal endportion to exit from said distal end portion; a catheter carrierstructured and arranged to associate a catheter with said proximal end,said catheter carrier including:a leading end portion including an exitfor a said catheter; a trailing end portion including an entry for asaid catheter; and a fluid trap chamber between said exit and saidentry.
 7. A ventilation circuit adapter for interfacing a suctioncatheter with an intubation device, comprising:a manifold assembly,having:a body with an open interior; a distal end portion of said bodybeing adapted to couple with said intubation device, a proximal endportion of said body being formed as an open port defined by acontinuous wall, said proximal end portion being approximately axiallyaligned with said distal end portion so that a catheter may be insertedthrough said proximal end portion to exit from said distal end portion;a catheter carrier structured and arranged to associate a catheter,having a distal tip, with said proximal end, including:a leading endportion; a trailing end portion; an internal catheter passageway locatedbetween said leading end and trailing end portions, said internalcatheter passageway including a fluid collector portion; and a positivestop mechanism arranged to prevent retraction of said distal tip of saidcatheter from said catheter carrier.
 8. An adapter according to claim 7,wherein said positive stop mechanism comprises a flare at said distaltip end of said catheter.
 9. A ventilation circuit adapter forinterfacing a suction catheter with an intubation device, comprising:amanifold assembly, having:a body with an open interior; a distal endportion of said body being adapted to couple with said intubationdevice, a proximal end portion of said body being formed as an open portdefined by a continuous wall, said proximal end portion beingapproximately axially aligned with said distal end portion so that acatheter may be inserted through said proximal end portion to exit fromsaid distal end portion; a catheter carrier structured and arranged toassociate a catheter, having a distal tip, with said proximal end, saidcatheter carrier including:a leading end portion; a trailing endportion; and an internal catheter passageway between said leading endportion and said trailing end portion including a fluid collectorportion; and a sealing mechanism at said distal tip, said mechanismstructured and arranged to seal said catheter passageway duringretraction of said catheter.
 10. An adapter according to claim 9,wherein said sealing mechanism comprises a flare at said distal tip,said flare constructed and arranged to provide a sliding seal againstsaid internal catheter passageway in said catheter carrier.
 11. Aventilation circuit adapter for interfacing a suction catheter with anintubation device, comprising:a manifold assembly, having:a body with anopen interior; a distal end portion of said body being adapted to couplewith said intubation device, a proximal end portion of said body beingformed as an open port defined by a continuous wall, said proximal endportion being approximately axially aligned with said distal end portionso that a catheter may be inserted through said proximal end portion toexit from said distal end portion; a catheter carrier structured andarranged to associate a catheter with said proximal end, said carrierincluding:a leading end portion; a trailing end portion; and a sputumtrap between said leading end portion and said trailing end portion. 12.A ventilation circuit adapter for interfacing a suction catheter with anintubation device, comprising:a manifold assembly, having:a body with anopen interior; a distal end portion of said body being adapted to couplewith said intubation device, a proximal end portion of said body beingformed as an open port defined by a continuous wall, said proximal endportion being approximately axially aligned with said distal end portionso that a catheter may be inserted through said proximal end portion toexit from said distal end portion; a catheter carrier structured andarranged to associate a catheter with said proximal end, said cathetercarrier including:a leading end portion including an exit for a saidcatheter; a trailing end portion including an entry for a said catheter;and a sputum trap between said exit and said entry.